title: Is vasoplegic syndrome more prevalent with open-heart procedures compared with isolated on-pump CABG surgery?
abstract: Postoperative vasoplegic syndrome (PVS) is a frequent complication and can affect the early postoperative course. Our study investigated the incidence and risk factors of PVS after on-pump isolated coronary artery grafting bypass (CABG) and on-pump open-heart surgery. A total of 629 patients underwent on-pump cardiac surgery from November 21, 2005, to June 9, 2006, at our institution. Of those, 334 patients underwent on-pump isolated CABG and 295 patients had open-heart surgery. PVS was defined based on the recognized criteria. Multivariate logistic regression analysis was used to identify the risk factors for PVS. The overall incidence of PVS was 11.7%. The incidence in isolated on-pump CABG surgery was 6.9% and 17.0% in open-heart surgery (P<.01). In multivariate analysis, isolated CABG reduced by half the incidence of PVS [odds ratio (OR)=0.45, P=.02]; preoperative left ventricular ejection fraction (EF) <35% was identified as an independent predictor of PVS (OR=2.1, P=.01), and a protective effect of female gender for PVS was observed (OR=0.4, P=.01). The association between angiotensin-converting enzyme inhibitors and other preoperative medical treatments was not confirmed by our study. In conclusion, PVS occurred less often after isolated CABG surgery than after open-heart surgery. Advanced age and low preoperative EF strongly predicted PVS.
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC 20010-2975, USA. xiumei.sun@medstar.net
authors.forename: Xiumei
authors.initials: X
authors.lastname: Sun
authors.forename: Steven W
authors.initials: SW
authors.lastname: Boyce
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Herr
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hill
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Corso
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Haile
authors.forename: Anne T
authors.initials: AT
authors.lastname: Lee
authors.forename: Robert E
authors.initials: RE
authors.lastname: Molyneaux
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D056987:Vasoplegia / Q000453:epidemiology*